Sgarbossa Criteria and Modified Sgarbossa Criteria

Sgarbossa criteria LBBB:

Left Bundle Branch Block or Ventricular paced rhythm, itself makes an ECG complex enough to differentiate from a true ST elevation Myocardial Infarction (STEMI).  [jpg]

New ECG changes indicative of LBBB should be considered and treated as pathological unless otherwise proved. However, the job is not quite easy.  Sgarbossa criteria defines a diagnostic scoring system based on ECG changes associated with LBBB and STEMI. A  score of 3 or more is specific for STEMI in LBBB. The Sgarbossa criteria is as under:

  1. ST elevation ≥0.1 mV in one or more leads in the same direction as the QRS, in the leads where the QRS complex is positive (concordance)  –  5 points
  2. ST depression ≥0.1 mV in one or more leads in the same direction as the QRS in V1 to V3, where the QRS complex is negative (concordance)-  3 points
  3. ST elevation ≥0.5 mV in one or more leads in the opposite direction as the QRS (Excessive discordance) –  2 points

Disadvantages of Sgarbossa Crieteria: 

Sgarbossa criteria is very specific (98%)  for STEMI in LBBB, but not sensitive (only 20%). That’s a big problem for a screening ECG.

Modified Sgarbossa criteria:

Smith, Stephen W modified the Sgarbossa criteria to make it more accurate and sensitive (upto 90%). The modification is for Sgarbossa criteria no 3 mentioned above. The modified Sgarbossa criteria is:-

          ST elevation or depression  ≥0.5 mV in one or more leads in the opposite direction as the QRS (Excessive discordance)  with a ST/S ratio of  0.25 or less

ST/S ratio of  0.25 or less means the ST deviation is bigger than 25% of the S wave amplitude. [momi]

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